Construct-ing AMR

I conducted ethnographic fieldwork with scientists at British research-intensive university to explore how scientists imagine, respond to and understand human-microbe relationships in the context of their research on antimicrobial resistance and respiratory tract infections.

In the past, language and imagery used to frame, communicate, and understand AMR draws on an understanding of microbes as antagonists in an ongoing ‘war’ with humans and in the UK academic research is an important branch of the UK Government's Contained, Controlled, Mitigated AMR strategy. My work explores how researchers at the University of Cityford reconfigure their understandings of health, infection and human-microbe relationships through their AMR research away from antagonism and toward more situated, emergent forms of relations. I explore how 'balance' and 'ecology' became key framing tools used by scientists for thinking through these relations and making sense of complex data as well as the challenges scientists faced articulating these through the imperatives of academic knowledge production in the UK.

What is AMR?

Antimicrobial substances are widely used by to treat and prevent infection in humans, plants and animals. Antimicrobials can be understood as essential tools for controlling non-human life to the extent that they can be considered infrastructures upon which modern biomedicine, industrial agriculture and economic productivity depend (Denyer-Willis and Chandler, 2019). Antimicrobial resistance (AMR) occurs when microbes develop resistance to antimicrobial substances like antibiotics and in doing so, resist human control.

AMR is a naturally occurring phenomena within microbial communities. The ability to produce antimicrobial substances (substances that kill other microbes) may give an organism an advantage in competition for resources and survival in addition to warning other organisms of threats in the environment. In 1928 penicillium mould was identified by Alexander Fleming as producing antimicrobial chemicals. Later, this chemical would be synthesised into the penicillin, the world’s first antibiotic. However, in response to these antibiotic and antimicrobial substances, microbes have developed resistance against them. The ability to produce or resist antimicrobial substances is encoded in genetic material. As microbes live, die and reproduce, they pass on genetic traits vertically from parent to offspring, and evolve over time. These traits therefore respond to environmental conditions and selection pressure, with certain traits appearing or diminishing over time. Due to their comparatively short lives, microbes evolve many times more rapidly than humans or other macrobes with potentially billions of generations of bacteria within a single human lifetime.

But this is not the only way in which genetic information is shared. Horizontal gene transfer (HGT), sometimes known as lateral gene transfer, allows organisms to share genetic material between organisms, cells and the environment. This allows for the swapping and sharing of advantageous genetic information in real time in response to stress or environmental conditions. The use of antibiotics, antifungals and other antimicrobial substances in agriculture, and for human, animal and plant health means that there is continual selection pressure for resistance genes. This causes resistances genes to proliferate and result in widespread AMR. This means that “even when new drugs, diagnostics tools become available, the persistence of HGT will require ongoing surveillance for newly resistant pathogens, leaving practitioner and researchers racing with evolution” (Burmeister, 2015).

Background to the Project

AMR has historically been framed in terms of military metaphors, building on the language of microbiology and bacteriology that framed microbes predominantly as threats to be eliminated, contained or controlled. In the 20th century, these ideas combined with the advent and proliferation of antimicrobial substances and other technical advancements in medicine and public health, led many to believe that infectious diseases would be eliminated altogether. However, these hopes were misguided. Antimicrobial resistance was identified since the advent of antibiotics, with major figures in the development of these substances warning of the threat of resistance since the beginning of their use. Since then, antimicrobial resistance, the ability for microbes to survive the use of substances used to kill them, has become a major threat to medicine, agriculture and wellbeing. Without antibiotics, biomedical procedures like c-sections, chemotherapy or hip replacements could become deadly due to the risk of infection; those with weakened immune systems will not have access to lifesaving medical care; and infectious diseases will have no reliable treatment. In agriculture, antibiotics are used to maintain productivity of animals and crops by treating diseases. A post-antibiotic future would entail a huge restricting of the world’s food supply.

 In light of these threats, the military metaphor for disease that had it’s origins in post war Europe came once more the fore. As the challenges and anxieties regarding AMR grew, so did the martial language that framed the problem. The “fight against AMR” against “superbugs” that would return us humans to the “dark ages” of medicine and leave us “defenceless” to illness and disease. Cold War politics, Star Wars and new economic structures influenced military metaphors to describe the immune system, creating imaginaries of human bodies as fortresses designed to resist microbial onslaught in popular culture, science communication materials and immunology textbooks used.

In recent years however, many key actors involved in ‘the fight against AMR’ have begun to move away from this framing. Scientific understandings of human microbe relationships have begun to understand the fundamental importance of the microbiome for human health: a discover that affirms the interdependence of human and microbial life. Greater understanding of climate change has focused attention on ecological interdependence. Increased global connectivity and more sophisticated data gathering systems have brought forth new kinds of collaborations. New approaches such as One Health incorporate human health, animal health and environmental health and greater interdisciplinary projects, conferences, funding opportunities and collaborations.